血清FGF21联合NT-proBNP预测第二代药物洗脱支架植入术后支架内再狭窄的临床研究

Clinical study of serum FGF21 combined with NT-proBNP in predicting in-stent restenosis after second-generation drug-eluting stent implantation

目的观察血清成纤维细胞生长因子(FGF)-21与第二代药物洗脱支架(DES)植入术后支架内再狭窄(ISR)的关系以及联合N-末端脑钠肽前体(NT-proBNP)预测ISR的价值。方法选取2019年1月—2021年6月海南医学院第二附属医院心血管内科一区接受二代DES经皮冠状动脉介入(PCI)的冠心病(CAD)患者175例,并在PCI术前采集外周血样本,通过酶联免疫吸附测定法检测血清FGF21水平。在PCI后9~24个月复查冠状动脉造影,并根据是否发生ISR分为ISR组32例和非ISR组143例。应用广义加性模型(GAM)探讨FGF-21与ISR风险的关系,多因素Logistic回归分析影响CAD患者DES植入术后2年ISR风险的临床因素,受试者工作特征(ROC)曲线分析其预测价值。结果ISR组血清FGF21水平高于非ISR组(Z=7.081,P<0.001)。多因素Logistic回归分析结果显示,支架总长度≥38 mm、NT-proBNP和FGF21升高是CAD患者DES植入术后2年ISR风险增加的独立预测因素[OR(95%CI)=1.072(1.040~1.106)、1.004(1.002~1.007)、1.038(1.021~1.056)]。血清FGF21水平和DES植入术后2年ISR发生率的拟合曲线结果显示两者呈正相关(r=0.508,P<0.001)。血清FGF21预测DES植入术后2年ISR风险的曲线下面积(AUC)为0.891,NT-proBNP的AUC为0.739,且FGF21联合NT-proBNP预测的AUC为0.966(P<0.001)。结论血清FGF21是接受二代DES PCI治疗的CAD患者2年ISR风险的独立危险因素。联合FGF21和NT-proBNP对ISR的预测潜力具有更高价值。

Objective To investigate the relationship between serum fibroblast growth factor(FGF-21)and in stent restenosis(ISR)after second-generation drug eluting stent(DES)implantation,as well as the value of combining N-terminal proBNP to predict ISR.Methods One hundred and seventy-five patients with coronary heart disease(CAD)who underwent second-generation DES percutaneous coronary intervention(PCI)in the Cardiovascular Department of the Second Affiliated Hospital of Hainan Medical College from January 2019 to June 2021 were selected.Peripheral blood samples were collected before DES PCI,and serum FGF21 levels were detected by enzyme-linked immunosorbent assay.Coronary angiography was reexamined 9 to 24 months after PCI,and 32 cases were divided into an ISR group and 143 cases in a non ISR group based on the occurrence of ISR.Application of Generalized Additive Model(GAM)to explore the relationship between FGF-21 and ISR risk,multivariate logistic regression analysis of clinical factors affecting 2-year DES ISR risk in CAD patients,and receiver operating characteristic(ROC)curve analysis of its predictive value.Results The serum FGF21 level in the ISR group was higher than that in the non ISR group(Z=7.081,P<0.001).The results of multivariate logistic regression analysis showed that the total length of the stent≥38 mm,elevated NT-proBNP,and FGF21 were independent predictive factors for the 2-year increased risk of DES ISR in CAD patients[OR(95%CI)=1.072(1.040-1.106),1.004(1.002-1.007),1.038(1.021-1.056)].The fitting curve between serum FGF21 level and 2-year DES ISR incidence showed a positive correlation(r=0.508,P<0.001).The area under the curve(AUC)of serum FGF21 predicting 2-year DES ISR risk is 0.891,the AUC of NT proBNP is 0.739,and the AUC predicted by FGF21 combined with NT proBNP is 0.966(P<0.001).Conclusion Serum FGF21 is an independent risk factor for 2-year ISR risk in CAD patients receiving second-generation DES PCI treatment.The combination of FGF21 and NT proBNP has higher predictive potential for DES ISR.